Big Name - Big Changes

The big question a manual medicine physician has to ask himself or herself is what to do about deep, nagging, chronic joint and muscle pain that just won't go away with standard adjustment techniques, exercises, stretches or anti-inflammatory medicines of all kinds? It happens that most joint pains that are not due to significant and prolonged degeneration or autoimmune disease are caused by muscle imbalance and fasciitis. So, in order to answer the question, "What is Fascial Manipulation", I have to describe muscle dysfunction and fasciitis.

Have you ever thought about why your leg kicks forward everytime a doctor taps your knee with that little rubber hammer? It's pretty funny, isn't it? It always amazed me to think that a tap on the knee or elbow could make an involuntary movement in my leg or arm. As it turns out, there is a pretty amazing explanation for this. It's called the Muscle Spindle Fiber or, for simplicity, the MSF. The MSF is a part of the subconcious reflexes that control muscle activity. More specifically, it will cause the muscle to contract when stretched. The other main part is called the Golgi Tendon Organ, or GTO. It relaxes the muscle when stretched but is also involved in setting the baseline tension levels of any muscle. Both are key components of our position sense in general (known as Proprioception for you physiology buffs). Among other things, these reflexes control the relaxation of a muscle when it's antagonist (the one on the other side of the joint pulling the opposite direction) is activated. Basically, they control muscle firing patterns. They are very fast and they communicate with each other at the spinal chord level to protect joints and control movement. However, when a muscle is traumatized or inflamed these reflexes can become inhibited and sluggish due to "fascial adhesions" that surround the capsules containing the nerves. Other mechanical consequences of fascial adhesions are found in the centers of co-ordination which will be described later. The end result is that the fine motor control becomes dysfunctional and this perpetuates inflamation and accelerates the degeneration of the joint as it is no longer pulled correctly. This is where the "Poor Tire Alignment" analogy comes from. Our cars go through tires a LOT faster when the wheels are pulling in opposite directions instead of smoothly rolling down the highway in the same direction. The same applies to our joints and with improper muscle pull, the joints respond by wearing out and putting down a lot of new bone tissue where it doesn't normally belong.

These fascial adhesions are the consequece of what is known as Fasciitis. The term 'itis' refers to inflamation of any kind. You may already have known this. But when it is applied to fascia, that slippery and web-like sheet within which all the muscle cells grow, it becomes a whole lot more complicated than your garden variety painful red spot caused by a small splinter in your finger. When a muscle becomes inflamed it's fascia responds by growing more fibrous in an attempt to patch up the damage. As well, the "oil" (hyaluronan) that lubricates the spaces between these fascial sheets starts to thicken up and eventually causes those painful spots called "densifications". It creates a real mess over time and it does not fix itself with Advil, stretches or even exercises no matter how fancy the therapist's office is. In fact, exercise can make it worse as you further strengthen dysfunctional muscles, thus accentuating the inappropriate muscle mechanics. Stretching helps somewhat because it attempts to increase the flexability of collagen fibers but it cannot normalize the lubricant that has become thick and sticky. In recent studies, the flexibility gained by stretching has been shown to not only to be short lived but also to cause muscles to become temporarily weaker. This is due to the effects stated above in the Golgi Tendon Organ. When stretched it actually causes the muscle to become inhibited and weaker for a short time. In fact, this has been so convincing that Olympic athletes are no longer including stretching in their pre-event warm up routines. The best way to effect these reflex loops is through two manual medicine techniques that effectively change the way muscles function. The are described below.

Neuromuscular Re-education

In short, NMR is the direct manipulation of the muscle spindle fibers through controlled eccentric contraction while the therapist strips through the entire muscle length. These types of contractions are done while the muscle is lengthening. This work is very similar to other popular acronymous techniques like ART, Graston, or FAKTR, if you've ever heard of those. I like to think of this therapy as though I were pushing a rolling pin through a ball of bread dough. As you push through the ball of dough, it gets longer and thinner. The hypothesis (or conceptualized idea) is that the muscle elongates (like the dough) when the therapist pushes through it. In the process, this therapy pulls the fascial adhesions away from the capsules surrounding the muscle spindel fibers so that they can once again sense the movement of the muscle and, thereby, send the reflex messages to the spinal chord as well as "hear" what is coming in from other muscles. When the spindle is allowed to "feel" the stretch of the muscle it will respond by causing it to contract when stretched and perform it's part in the firing pattern loop. It will immediately fire stronger when tested and most patients are able to resume normal activity within a few days following a prescribed pattern of excersizes that are incorporated over the next 2 to 4 weeks. Since this therapy is deep and, at times, painful the patient is instructed to utilize ice massage therapy to minimize secondary inflammation. Ice is applied directly to the skin over the spot most irritated for 3 to 5 minutes or until numb. This process works to close down capillaries and slow the inflammation process thus allowing for better healing of the fascia and muscle tissue. But Neuro-musclular Re-education is only a small part of manual medicine and it (like ART, Graston, or FAKTR) does not fully evaluate the biomechanical implications of improper muscle mechanics caused by pathology. This is where Fascial Manipulation is so amazing.

This is rapidly becoming the most well researched and validated manual medicine technique in history. Originated in Italy by Luigi Stecco PT, it has finally found it's way across the pond to the United States. As of early 2011, only a handful of practitioners have been exposed to it but it is likely going to make an enormous impact on the world of manual medicine. Dr. Ed Traum is the only physician in the southwest who has completed all of the courses offered by the Fascial Manipulation Association. The basic premise is that there are certain points in the fascial sheets of muscles called "centers of co-ordination". This is where verctorial force convergence occurs when a group of muscles is contracted to effect a particular movement like straightening the knee. It is all based on muscle chemistry and physics and I can explain that better in the office. But for now, I'll try to hit the basics. A densification in this area of vectorial force convergance of the muscle lubricant called hyaluronan blocks smooth force transference and forces the muscle to find an alternative route to accomplish the task you are asking it to do. More importantly, it inhibits those special nerves (MSF/GTO) that communicate with all the other muscles so that proper balance is impossible to maintain. Eventually, this dysfunction causes more problems up the fascial sheath and even starts to effect the other muscles involved with the movement. The body can accommodate this for a period of time but, eventually, pain becomes your new shadow.

These densifications are composed of concentrated hyaluronic acid, which is that "oily" substance we spoke of earlier. When highly concentrated, these little "ball bearings" begin to combine to form larger and larger molecules which eventually begin to stick together like butter on a cold day. But unlike butter, they do not liquify when you heat them. They might feel better for a while but they will not begin to truly break apart into their typical smaller parts until acted upon by a foreign power. It is the application of force that creates the needed pressure and friction that initiates the break up process of this thick gel. Secondarily, the localized chemical inflammation caused by the therapy is required to complete the job by breaking up the large molecules into smaller and smaller pieces. This is what I call "Targeted Micro Trauma" and it is the most important part of Fascial Manipulation therapy. As the Hyaluronan begins to break down this will allow the fascial sheets to slide across each other more freely thus allowing more appropriate distribution of the mechanical force of muscle contraction. Once this is achieved the nerves that control our movements will again be able to freely communicate with each other resulting in better joint mechanics. Whereas inflammation is controlled after treatment involving NMR, it is actually encouraged in the centers of co-ordination that have been worked on. This is why I have coined the term "Targeted Micro Trauma". No ice, Advil, or enzymatic anti-inflammatory therapy is recommended. We actually want this tiny bit of inflammation to run its course.

We are so confident in this process that if we cannot demonstrate any improvement after 5 treatments then your cost of treatment will be returned to you. That is a guarantee straight from Dr. Ed Traum.

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Testimonial

As a professional powerlifter I ask a lot of my body. In November 2012 I broke my world record dead lift at 854 pounds and I found that the work of Fascial Manipulation was a critical component of my training regimen.